CLINICALS

Nitrofurantoin

What antibiotic drug used for urinary tract infections is a well-known cause of drug-induced interstitial lung disease?

Pleural effusions and pleural thickening

What two pleural findings on HRCT suggest drug toxicity or CTD?

Amiodarone

What antiarrhythmic drug chemical is a common cause of pneumotoxicity and drug-induced interstitial lung disease?

Inhaled bronchodilators

What drug class is central to symptom management in COPD and commonly given on a regular basis?

Play or exercise

What physical triggers can act as aggravating factors for respiratory symptoms?

H2 blockers

Which class of gastrointestinal medications is listed as a potential risk factor for developing asthma?

Oral candidiasis

What local side effect is caused by propellant-induced mucosal irritation and local immunosuppression in the oral cavity?

Hoarseness

What local side effect is caused by dysphonia resulting from vocal cord myopathy?

Chest radiograph PA and lateral upright

What is the most appropriate initial diagnostic procedure for a 20 year old cachectic female presenting with 1 month of weight loss, low grade fever, cough refractory to antibiotics, decreased breath sounds, and increased tactile fremitus on the right?

Gastroesophageal reflux disease GERD

What disease can cause chronic cough in patients with entirely normal lung parenchymal imaging?

CBC, ABG, serum electrolytes, chest X-ray

What four laboratory and diagnostic tests are indicated for patients presenting with severe asthma distress?

Consolidation

What does the term bronchogram indicate or represent when heard in chest imaging?

Surrounding inflamed and necrotic tissue

What do the thick walls of a cavitary lesion represent on CT scan?

Signet ring sign

What CT sign is present when a cross-section of a dilated bronchus appears larger than its accompanying pulmonary vessel?

Dysphagia, reflux symptoms, skin changes/rashes, Raynaud's Phenomenon, arthralgia/morning stiffness, sicca dry eyes/mouth, and proximal weakness

What seven signs and symptoms should prompt a clinician to suspect CTD in an ILD patient?

New ground-glass opacity with traction bronchiectasis, new fine reticulation, increased extent or coarseness of reticular abnormality, new/increased honeycombing, and increased lobar volume loss

What five other HRCT findings represent radiological evidence of PPF progression?

Interstitial lung disease

What is the top differential diagnosis to consider in Case 1 because its symptoms are non-specific and easily missed?

Prednisone

What systemic corticosteroid is the standard first-line treatment for inflammatory lung diseases like sarcoidosis?

Skin manifestations

What inspection findings may be present in a patient with interstitial lung disease?

Multidisciplinary Discussion MDD

What collaborative diagnostic concept is applied to combine clinical, radiological, and pathological findings to reach a consensus diagnosis?

Interprets medical history, clinical data, and PFTs, and diagnoses/treats ILDs

What are the specific diagnostic and management roles of the pulmonologist in the MDT?

Improvement away from work on weekends or holidays

What characteristic symptom timing suggests a diagnosis of occupational asthma?

Chest drainage

What is the most appropriate immediate management for a 77 year old male presenting with 1 week of progressive dyspnea, dry cough, fever, loss of appetite, a 30 pack year smoking history, a history of prostate cancer in remission, and complete opacification of the right hemithorax with midline mediastinal structures?

Cysts, marked mosaic attenuation, predominant GGO, profuse micronodules, centrilobular nodules, nodules, and consolidation

What are seven HRCT features suggestive of an alternative diagnosis?

More invasive workup (BAL, TBLC, surgical biopsy)

What is required if the HRCT pattern is indeterminate or suggests another diagnosis?

Symptom control and advanced care

What management strategy combines pharmacological and non-pharmacological interventions for persistent symptoms?

Intractable cough

Which respiratory symptom is noted as especially difficult to manage in ILD?

Palliative care

What service should be integrated early to improve symptom management and facilitate end-of-life planning?

Spleen, kidney, or bone marrow

What organs can have associated diseases excluded or suggested by lab test results in a systemic disease context?

Inhaled Corticosteroids (ICS)

What pharmacological class represents the cornerstone anti-inflammatory treatment for asthma, targeting Type 2 inflammation?

Autoimmune diseases on chronic steroids or immunomodulating drugs, hematologic malignancy, prior chemotherapy

What are causes of immunodeficiency other than HIV that increase likelihood of infectious respiratory symptoms?

Bronchiectasis or hemoptysis

For which two presentations is a Chest CT scan particularly helpful?

Creatinine

Which blood test is checked because renal failure can cause pulmonary congestion due to fluid retention?

Severe anemia

What chronic cause of dyspnea is characterized by low hemoglobin leading to impaired oxygen delivery?

Chest pain and Pancoast syndrome

What respiratory presentation is commonly caused by a Pancoast tumor?

Pregnancy

What is an example of a hormonal trigger that can affect airway narrowing and asthma control?

Peak expiratory flow or PEF

What measurement should be used instead of relying on symptoms alone if spirometry is unavailable?

Viral infections, exercise, allergen exposure, changes in weather, laughter, irritants

What are six common triggers of characteristic asthma symptoms?

Car exhaust fumes, smoke, strong smells

What are three examples of irritants that commonly trigger asthma symptoms?

Pneumonia and bronchiolitis requiring hospitalization

What are two severe lower respiratory tract infections in early childhood that act as risk factors for persistent asthma?

Airway smooth muscle

With what tissue do mast-cell-derived mediators make direct contact to cause acute bronchoconstriction?

Exercise, laughter, allergens, cold air

What are four common triggers that can worsen typical variable respiratory symptoms?

Mycoplasma pneumoniae and Chlamydia pneumoniae

What are two atypical bacterial infections that can act as triggers for childhood asthma?

Cystic Fibrosis

What condition should be considered in children presenting with excessive cough, mucus production, gastrointestinal symptoms, and failure to thrive?

Cystic fibrosis, allergic bronchopulmonary mycoses, immune deficiencies

What are three underlying conditions that may be present if a chest CT is positive for bronchiectasis?

Liver

What structure does the diamond symbol represent in the axial chest CT scan at the lung bases of Figure 10?

Homogenous gray areas

How is lung consolidation represented visually on the CT scan in Figure 10?

Pockets of lucencies within the consolidations

How are cavities represented visually on the CT scan in Figure 10?

Septic shock or toxic inhalation

What are two common causes of direct lung injury causing pulmonary edema?

Passive atelectasis

What parenchymal lung change is caused by the compressive effect of adjacent pleural fluid?

Coughing and airway obstruction

What are two common clinical symptoms caused by squamous cell carcinoma due to its central location?

Alternative diagnosis

If clinical evaluation successfully identifies a potential cause or associated condition in an ILD suspect, what is the immediate diagnostic path?

Chest HRCT scan assessment

If potential causes of ILD are excluded, what is the next diagnostic assessment performed to evaluate the pattern?

There are actually no specific laboratory tests that allow for the diagnosis of ILD

What specific laboratory tests are diagnostic on their own for establishing the cause of ILD?

To provide clues to rule out other common conditions such as left heart failure, infections, and cancer

What is the diagnostic utility of performing an initial chest X-ray in an ILD suspect presenting with shortness of breath?

Unexplained breathlessness, persistent dry cough, inspiratory crackles, hypoxemia at rest/activity, reduced exercise capacity, and PFT restriction/reduced DLCO

What six clinical manifestations should prompt a clinician to suspect ILD in a patient with a known CTD?

15 to 20 percent

What percentage of patients with mild or early asbestosis present with a negative chest X-ray?

Rhinitis and conjunctivitis

What two mucosal symptoms frequently precede or coincide with asthma symptoms triggered by HMW agents?

Rhinitis, pharyngitis, and laryngitis

What three clinical conditions are caused by upper respiratory tract inflammation from soluble pollutants?

In an individual over the age of 40

At what age should spirometry be performed if any key indicators of COPD are present?

Gas trapping

What causes the decrease in FVC on spirometry in a COPD patient?

10

What COPD Assessment Test CAT score serves as the cutoff for separating less symptomatic from more symptomatic patients?

Theophylline

What oral bronchodilator exerts a small bronchodilator effect with modest symptomatic benefits in stable COPD?

Methylxanthines

What drug class is explicitly not recommended for the management of COPD exacerbations?

Laryngoscopy

What is the most appropriate initial diagnostic procedure for a 56 year old male presenting with persistent hoarseness of voice for 2 months, a 20 pack year smoking history, and an otherwise unremarkable physical exam?

Chest computed tomography CT scan

What is the next diagnostic step if a patient presents with vocal cord paralysis on laryngoscopy but has no obvious vocal cord nodules or structural abnormalities?

Chest radiograph

What is the best simple option for an initial thoracic diagnostic procedure because it can display several thoracic structures at once?

Sputum tests for tuberculosis

What was the next diagnostic step in Case 2 based on the 20 year old female patients clinical presentation and demographics in the Philippines?

Sputum Grams stain and culture

What is the most appropriate initial diagnostic procedure for a 35 year old never smoking male presenting with 1 week of fever, cough, chills, a history of male to male sexual relations, tachycardia, tachypnea, hypoxemia at 85 percent on room air, fine crackles, and bilateral patchy infiltrates?

Three

How many case studies are presented to illustrate the diagnostic approach?

Pump problem

What is a respiratory distress problem caused by a defect in the chest wall or muscles?

Congenital heart disease

What structural heart defect can cause respiratory distress in young infants?

Exercise-related symptoms

What triggers recurrent symptoms in school-aged children with asthma?

Dysfunctional breathing

What respiratory pattern issue causes chronic symptoms in adolescents?

Infection, trauma, or foreign body aspiration

What causes should be considered if upper airway obstruction symptoms occur later in life?

Vocal cord paralysis, congenital subglottic stenosis, congenital cyst, or tracheal webs

What are the potential congenital causes of upper airway obstruction presenting immediately post-delivery?

Infectious causes, trauma, or foreign body aspiration

What are the most common causes of upper airway obstruction presenting at 1 to 4 years of age?

Vascular rings and slings

What cardiovascular cause of upper airway obstruction presents with biphasic stridor, feeding difficulty, and no fever?

GERD

What gastrointestinal condition presents with regurgitation, cough or stridor after feeds, and a hoarse cry?

Hypocalcemic laryngospasm

What metabolic cause of upper airway obstruction presents with perioral numbness and carpopedal spasm?

Third-generation cephalosporin such as ceftriaxone or cefotaxime

What class and specific examples of antibiotics are used to treat epiglottitis?

Clindamycin, vancomycin, and a third-generation cephalosporin

What antibiotics are used to treat bacterial tracheitis?

Third-generation cephalosporin plus ampicillin/sulbactam or clindamycin

What antibiotics are used to treat a retropharyngeal abscess?

Ventilatory restrictive defect

What type of lung defect is caused by the increased lung stiffness from fibrosis and scarring?

Mycophenolate mofetil (MMF), Cyclophosphamide, and Rituximab

What are three immunomodulatory drugs used in the management of CTD-ILD?

Exertional dyspnea, dry cough, and Velcro-like crackles

What is the classic clinical triad of symptoms that should prompt a clinician to suspect ILD?

Brain Natriuretic Peptide (BNP)

What cardiac protein biomarker is elevated in blood tests to diagnose congestive heart failure in patients presenting with dyspnea?

Short-Acting Beta-Agonists (SABA)

What class of quick-relief bronchodilator drugs, including salbutamol, is the first-line treatment for acute bronchospasm?

Long-Acting Muscarinic Antagonists (LAMA)

What class of inhaled bronchodilators, including tiotropium, is the preferred first-line maintenance treatment for stable COPD?

Ceftriaxone or Cefotaxime

What two third-generation cephalosporin antibiotics are the first-line treatment for acute epiglottitis?

Ampicillin/Sulbactam

What beta-lactamase inhibitor combination antibiotic is combined with ceftriaxone for the medical management of a retropharyngeal abscess?

Diphtheria Antitoxin

What specific hyperimmune globulin drug must be administered immediately along with intravenous antibiotics to treat diphtheria?

Corticosteroids

What class of anti-inflammatory drugs is the first-line treatment for acute exacerbations of IPF or hypersensitivity pneumonitis?

Epinephrine

What catecholamine drug is administered intramuscularly as the first-line emergency treatment for systemic anaphylaxis?

Calcium

A deficiency in what divalent cation element causes hypocalcemic laryngospasm presenting with carpopedal spasm and stridor?

Beta blockers and ACE inhibitors

Which medications in the patient history may cause cough or bronchospasms?

Aspirated foreign body, GERD, Laryngopharyngeal Reflux LPR, Obstructive sleep apnea OSA, ACE inhibitors

What are non-infectious, non-cardiovascular, and drug causes of cough?

Lung contusion, drugs like cocaine, anticoagulants, antiplatelets, biopsy, autoimmune DAH, catamenial, clotting disorders

What are non-infectious, drug, and traumatic parenchymal causes of hemoptysis?

Cocaine

What illicit drug can cause parenchymal hemoptysis?

Controller

What is the term for medication that targets both domains of asthma control, including symptom control and future risk?